The purpose of this proposal is to evaluate the effects of improved records access due to the COSTAR ambulatory records system on the quality of outpatient care. In order to accomplish this, the resident teaching clinic of the University of Nebraska Department of Internal Medicine will be divided into two groups. A "study" group will have only computer records available. A "control" group will have only the conventional medical record. Using a dictated, problem oriented note system, each group will have identical methods of data entry. During a two year, prospective study, systematic observations will be made on the process and outcome of outpatient care. Process items for study will include: 1) patient satisfaction, 2) speed of records acquisition, 3) records economy and content, 4) acceptability to physicians and staff and 5) clinic flows and waiting times. The outcome of medical care will be compared in five areas: 1) compliance with health screening, 2) complications of drug therapy, 3) treatment of hypertension, 4) treatment of congestive heart failure and 5) management of acute cystitis. The controlled study design and breadth of inquiry will permit valid conclusions regarding the usefulness of computerized ambulatory records compared to current records systems. This project will be important for health planning and implementing medical computer applications in the ambulatory setting.